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B.C. teens, twenty-somethings turn to Botox for forever 21 look

Carly Roberts, 25, first began Botox treatments two years ago and has been receiving injections every three months ever since. She sees the treatments as pre-emptive, minimizing the onset of wrinkles as well as preventing headaches and skin breakouts.

Roberts has been unapologetically using Botox — a widely used drug, made famous by youth-seeking Hollywood stars and certain reality-show housewives, that weakens or paralyzes muscles — to fend off wrinkles and skin creases for two years now.

Along with injections between her eyes and forehead, she also regularly uses Botox under her arms to reduce sweating.

Is such devotion to a drug excessive at such a young age? Roberts doesn't think so.

"I still have a little bit of expression left. Not huge . . . But my face isn't frozen or anything like that," she said.

Roberts is part of a growing number of B.C. women in their teens and 20s who say they are turning to the toxin to pre-empt signs of aging, despite the financial cost and health concerns around its use.

"I see 20-year-old women not wanting to have wrinkles," said Dr. Warren Roberts, Carly's father and an oral surgeon who is licensed to administer Botox in the province.

Roberts said the majority of his patients tend to be women between the ages of 35 and 60, but estimated roughly 25 per cent of his clients are teenage girls or women under 30.

"I couldn't give an exact amount, but it's increasing," he said.

Botox procedures among teenagers in the U.S. increased nearly 800 per cent between 2008 and 2010, according to the American Society of Plastic Surgeons. Among women in their 20s, injections increased by more than 11 per cent to 78,000 in 2010 alone.

Statistics for Canadian procedures are unavailable publicly.

In 2008, B.C. became the first jurisdiction in Canada to permit dentists and oral surgeons to administer Botox for cosmetic purposes, allowing greater access to the popular toxin for patients of all ages.

Physicians, surgeons, and even registered nurses — if a supervising doctor is on site — are also authorized to administer Botox in B.C. Professionals must complete a course, generally an hour and 15 minutes long, by an instructor approved by Allergan Inc., the California-based pharmaceutical company that makes the drug.

Botox is used mainly to reduce unwanted wrinkles around the eyes and forehead, but also to relieve symptoms in patients with cerebral palsy as well as migraines and chronic sweating.

Over the last five years, Dr. Roberts said he's seen an increasing number of teens come to his office, a sleek downtown Vancouver studio with pebbled glass panelling and white leather chairs, for upper lip injections following orthodontic treatment.

Many worry about having gummy smiles.

"They smile and they have these beautiful, straight teeth and all you can see is this big band of pink tissue on the top," Roberts said. "With Botox, $24 of treatment would decrease the hyper-mobility of that lip and put it exactly where it's supposed to be."

Not everybody gets off that easy. Patients usually dish out between $300 and $1,000 per treatment, depending how much of their foreheads, eye creases, mouths and necks they care to submit to the needle's touch.

The muscle-numbing effects last three to four months before a top-up is needed.

Botox, a trade name for botulinumtoxin A, is a protein complex produced by a bacterium containing the same toxin that causes food poisoning, or botulism.

Botox users often rave about its results, but the drug — which has no age restrictions — is not without controversy.

A 2008 Health Canada review cited "the potential risk of serious adverse effects of muscle weakness remote to the site of injection." These include pneumonia and difficulty speaking or breathing.

That same year the federal health agency launched a probe into the deaths of five people who had been injected with Botox, and serious reactions in another eight cases.

All the deaths involved people who were treated for such medical conditions as neck and muscle spasms. Two occurred in children with cerebral palsy, including a nine-year-old boy given Botox for drooling — a condition for which the drug has not been approved.

The reactions in all cases suggest the botulinum toxin may have spread to other parts of the body beyond where it was injected, according to Health Canada.

Health Canada found that spread of the toxin and other serious side effects were very rare in cosmetic procedures, however, the danger increased when Botox is used in larger doses to treat medical conditions involving muscle spasticity.

More common complications that arise from botched cosmetic injections include pain or bruising, headaches and eye swelling, skin rashes, muscle weakness and an irregular heart beat, according to Health Canada. Droopy eyelids and swallowing difficulties are also possible hazards.

Dr. Roberts said he's never had any problems, but added clients should be mindful of where they get the procedure done.

"I hear from doctors from around the world through my LinkedIn account who obviously don't know what they're doing," he said.

Nonetheless, Botox injections remain by far the most popular "minimally invasive procedure" in plastic surgery, beating out chemical peels and collagen injections, according to the American Society of Plastic Surgeons.

For some, plunging a Botox-filled syringe into a young woman's skin poses more emotional risk than physical, and speaks to an insidious undercurrent of superficiality coursing through west coast culture.

"At age 13, what is it preventive of?" asked Dr. Gayle Way, a Vancouver-based psychologist. "The big fear is that, 'Oh my gosh, I'm going to turn 30.' Is it happening more in B.C. because we're kind of the California of Canada? Could be."

"Because they don't realize that they have an inner self that they can work on . . . the only way they see to feel better about themselves is to improve their appearance," she said. "They're desperate to look as great as they can at a ridiculously early age, even though they don't need it."

Monk points to celebrity culture and an accompanying obsession with appearance imprinting itself on girls.

"Celebrities are getting plastic surgery younger and younger, and young women are seeing that in magazines, on TV, in the movies, and they're associating their glamorous lifestyles with plastic surgery," she said.

Dr. Roberts, on the other hand, feels cosmetic treatments have the power to make patients feel better about themselves.

"Our patients that we use Botox on between the eyes and particularly in the forehead become less anxious and have less anxiety and depression," he said. "It makes my day."

Dr. Elizabeth Hall-Findlay, an Alberta-based plastic surgeon and who happily uses Botox herself, said using the drug can help young clients keep their skin looking younger by preventing the formation of deep creases.

But, she said, staying out of the sun would probably do them more good.

Carly Roberts has no regrets about her own cosmetic choices.

In addition to using Botox to preserve her youthful skin, she said it also relieves headaches and skin breakouts. To her, injections are as common as a pedicure or a salon visit.

And she's not alone. A similar attitude prevails within her circle of friends.

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